Monday, June 04, 2007
TB case: Could you have done the same?
"Mom, I really don't want to go. I'm so itchy," I whined.

"You have to go. That's the plan. Your aunt is expecting you," my mother told me as she wrapped a scarf around my neck and put sunglasses on my little head to cover up the marks. I was 8 years old.

"But I'm not allowed on the airplane with chicken pox. If I had school, I wouldn't be allowed to go there," I pressed.

"You'll be fine. Just don't talk about chicken pox," my mother commanded as she nudged me on that plane alone headed toward Mississippi for summer vacation.

For good or bad, my childhood experience has made me question how differently I would have acted had I been in Andrew Speaker's shoes.

For sure, tuberculosis and chicken pox are very different. Just a few facts on your average tuberculosis (less serious than Speaker's "extensively drug-resistant," or XDR-TB): About a third of the world's population is infected with tuberculosis and most cases are latent, or not active.

Tuberculosis kills approximately 1.6 million people a year. The bacteria take over your body and keep it from functioning properly. "It's been called consumption because people literally waste away. You end up looking like a concentration camp victim," says Dr. Max Pomerantz, a TB expert and surgeon at University of Colorado at Denver Health Sciences Center.

Each person with tuberculosis infects 10 to 15 other people, usually by coughing germs into the air, according to the World Health Organization. Once inside a new host, TB develops in 5 percent to 10 percent of healthy people. In the remaining people it can be carried around for years or decades without causing any symptoms. The dormant TB can be triggered to activity by a disruption in the immune system.

To be clear, extensively XDR-TB is no more virulent or contagious than non-resistant tuberculosis. It's more dangerous because it does not respond to some of the strongest antibiotic treatments in existence. It's very difficult and very expensive to treat. Andrew Speaker faces a two-year course of treatment and his doctors in Denver approximate it will cost at least $250,000 to $350,000 for his care at National Jewish Medical Center.

So armed with all that information, I'd like to say that I wouldn't have tried to get on a plane home after authorities warned me I was a health risk, but to be honest I'm not absolutely certain. Speaker apologized to his fellow passengers on "Good Morning America" on ABC: "I don't expect those people to ever forgive me. I just hope they understand that I truly never meant them any harm."

How would you have acted? Would you have stayed in a foreign country's hospital after being warned? If you didn't have symptoms, would you have believed you were a public health threat? Do you think Andrew Speaker should be held liable? Do you have more questions about tuberculosis? Do you think the TB case merited so much media attention?
Chris:

Absolutely not- I would never have done that. In my opinion, I feel that so many people nowadays are completely self-absorbed and could care less about other people's welfare!

And of course I would have believed I was a threat even without symptoms. Just because you can't feel it, or you "feel fine" doesn't mean that the cooties you have are no longer present. I feel that if someone gets sick or even dies as a result of this man's disturbing lack of morality, he should definitely be held accountable. It was a result of his intentional actions, correct? As to what did (put others at risk)... well, I'm just shocked and appalled.

I don't so much think that this one particular case should have been given quite so much attention that it has. Hopefully it did not cause widespread panic, and I would think that it may have caused a little alarm because so many people are unaware of how the disease spreads and/or how to be tested for it. It did bring to light, however, the question of human rights versus safety of the public, and also a greater awareness of the problems within the CDC and how they would react to a widespread epidemic. The CDC's response is the part that makes me a little nervous....
Perhaps people don't realize that Typhoid Mary was a real woman who worked as a cook and had Typhoid. When the disease was traced back to her, she was quarantined for life for the good of everyone else.

This guy, as a lawyer and having a father in law who's a TB specialist doesn't have the excuse that Mary had - she had no symptoms and no reason to think that she was ill.

There is no forgiving him being so selish as to put others in severe danger.

Since we are now in a position to charge and convict people with AIDS who have unprotected sex, I don't see why this man should be let off the hook for putting people at risk for their lives through causal contact and coughing.
If this was me, I would have not only remained home, but isolated myself from the general population so as to not infect and essentially murder other people.
If the accounts that I'm ready are correct, then I think that I would have done exactly the same as Andrew Speaker.

Although he was encouraged not to fly, doctors told him that he was not contagious and was not prohibited from flying to his honeymoon. Finding out that he had the more drug resistant type of TB DID NOT make him more contagious, so why should he be prohibited from flying home?

Would you trust your life in the hands of a foreign hospital that you knew nothing about? And if the reaction of the U.S. government was to panic, flag his passport, and try to stop him from re-entering the country, what might the reaction of a foreign government have been? A bullet in the head, perhaps?

To all those who would condemn him for his actions, it is easy to say that you would have done differently when cuddled all safe, sound, and healthy in your homes. In reality, nobody really knows what they would have done until faced with the situation. I'm betting most of us would have tried everything possible to return to the U.S. for treatment.
Personally, I would have tried to come back home as well. But wait, I would have never left in the first place. Whether or not authorities tell you that you are okay, TB is a serious disease, especially the type of TB that he has. To just brush it off like that... He'll just have to live with his decisions, but I don't think he'll feel remorse for anything he has done regardless of his dishonest attempts. I think that he is just so glad that he is back at home getting the treatment no matter how many people he has put in danger.
I wouldn't have been on that plane because I would have taken the disease seriously enough to enter treatment immediately.

Typhoid Mary was a real person, but she wasn't quarantined for life immediately. She was quarantined for a while, and then released on the orders that she not work with food, which she did, killing more people. Then she was quarantined for life. That example shows that you can't trust everyone to do the right thing, the cautious thing, just because it's the right thing to do to ensure the protection of other people. Public health protects the health of the community, not the individual, and rights of individuals have to be weighed with the greater good of the whole. In this case, his rights have to be waived, as Typhoid Mary's were, because both Andrew Speaker and Mary didn't have any concern for the health of the community as a group of individuals who have a right to not be recklessly exposed to illness.

Andrew Speaker recorded the meeting with his doctors because he knew he was doing something questionable and he wanted evidence later that he didn't technically violate orders. He flew into Canada because he knew he had been placed on a no-fly list into the US. These are things that people who are behaving morally and ethically do not have to do. He did these things because he knew he was behaving poorly and with no regard for others, and his apologies should be taken with that in mind. They are worthless.

Additionally, if he had truly been concerned about the welfare of people he encountered, no matter how little the chance of infection was, he could have worn a face mask.
I cann't help but wonder if the cdc is utilizing the media do redirect any attention from themselves related to any mishandling themselves. As a healthcare worker, we are exposed every day and if we are told that we have nonactive tb, its our choice to take treatment or not. We are working side by side with ppd positive, but not active fellow employees every day. This doesnt mean that we need to be isolated.
It's only a matter of time until Speaker's wife and/or one of those airline passengers is diagnosed with TB. One of my co-workers contracted chicken-pox after a woman was allowed to board the plane with a child broken out -and they sat 4 rows behind him.

A prudent person diagnosed with an infectious disease would not travel for any reason until getting themselves taken care of. By his actions, Speaker revealed himself to be an ignorant self-centered jerk who likely didn't want to forfeit honeymoon deposit money.

With the global situation these days, the U.S. should not allow any person diagnosed with T.B. or other infectious disease to board a plane/train/or ship. Passengers breathing recycled air are all at risk, and it is unbelievable that anyy competent physician would not forbid public travel after diagnosing T.B. If the U.S. doesn't take steps now to control such situations - the next pandemic is just around the corner.
It's easy to judge but I think most people would have traveled to Europe for their long-planned (and I'm sure, extremely expensive) wedding under the same circumstances. As far as traveling back to the U.S. the way Mr. Speaker did, that is open to debate, but I think he made the right decision. Let's all remember that this is not a typical case of TB. He is smear negative. He may not be infectious AT ALL. So far his wife, who has had far more extensive contact with him than any airline passenger is negative. I'm a little shocked at the hateful responses. Are we all so perfect that we can throw stones? How about a little charity from the masses? There is no evidence that Andrew Speaker is a horrible person who was trying to hurt people. On the contrary, he sounds like a very nice guy (after all, he probably contracted the infection while doing charity work in Asia).
Anonymous, who said "With the global situation these days, the U.S. should not allow any person diagnosed with T.B. or other infectious disease to board a plane/train/or ship."

I would like to correct you on a particular detail -- Latent TB is NOT contagious and people who have the bacteria but are not actively sick CANNOT spread the disease. Only those who have active TB can spread the disease - most people who have active TB would feel the symptoms, go to a doctor and get the antibiotics they require.

Because latent TB is not contagious, I don't think your argument for stopping those with TB from traveling is sound. Andrew Speaker is a rare case of TB, and he does not represent ALL people with TB.
My husband and our daughter traveled to Greece in the 80's after winning a TWA prize. Upon their return they became seriously ill, so we immediately got to the doctor. They had contracted a communicable intestinal ailment and were quarantined to our home by the health department. It was made clear to us by the health authority they were not even to be around our younger daughter. We observed the quarantine judiciously and no one else became ill. Observing standard precautions work, and it would have been criminal for us to expose neighbors and the public to their illness.
Tuberculosis is insidious, and it is outrageous this personal injury lawyer went without a mask into close confinement for hours with other passengers. I object to suing on almost any grounds, but in this case I feel the countries he visited, the airlines he chose to fly on to avoid being inconvenienced, and any who are suffering the torment of waiting to learn if their tb tests come back positive have valid grounds for suing this lawyer. He should not have got on the plane to Europe in the first place. Once there and having learned he had a particularly difficult to treat case, he should have stayed in quarantine there. European countries have excellent health care, and anyone who can afford to set up a wedding overseas surely could have afforded to stay there for care, if they didn't have the decency to not fly overseas, without a mask, in the first place.
This is just something to think about. Correct me if I'm wrong, but I'll bet that more people die from the flu, strep throat, and even the chicken pox than other more common illnesses than the XDR-TB. And yet, these common illnesses are way more contagious, and I cannot remember a time where I have been on an airplane where I have not sat near someone who was hacking up a lung all over the place.

And anyway, they told him he was not contagious...would you cancel your wedding if you found out you have a disease that is not contagious and you are not even showing symptoms yet?
Sure, Speaker said, " I truly never meant them any harm."

I'm sure a drunk driver never means harm on passers by either.

However, the situation is analagous because both Speaker and a drunk driver thought only his own wants and not for people he may meet along the way.

I guess all those lives were worth less than the cost of already-booked hotels and airfare.
I would never have gotten on the plane with a diagnosis of TB no matter how "benign" I was told that diagnosis it would be. It was selfish and wrong for Mr. Speaker to have done so. Shame on him.
I don't know what I would have done in the same circumstance, but he was told he was NOT contagious. That said, he went on with his life NOT knowing he had XRD tb. My question is, why did it take so long to diagnosis this type of tb? He found out in January he had tb but did not know he had the resistant xrd until he was on his honeymoon five months later? Come on!! Somebody was asleep at the wheel. Mr. Speaker should have been advised MONTHS earlier than what he was told. I think the CDC has a lot of explaining to do. As far as I can tell, they were the ones who dropped the ball and let Mr. Speaker down. I am so sorry that he is getting such horrible comments. He made a decision on based on the information that he was given. Did he make mistakes? Yes he did, but so do we all. If nothing else, he taught this country that we are vunerable on our borders and that is far scarier. I do not wish him ill will and hope that he can overcome this illness that has overtaken his life. He has said he was sorry and with that said we are to forgive.
Although it would seem to take only common sense to cancel travel plans if you have any kind of TB, let's say he was told he was not contagious. It does not change the fact that, after being told in no uncertain terms to NOT TRAVEL on a commercial airline back to the US, he deliberately snuck back in. Now, if he was in a country without advanced medical treatments, I may have sided with him. But Rome has some of the best hospitals in the world. Even Paris, if he wanted to drive there. Instead, he blatantly disregarded the safety of others to insure his own. That's what I think people find so unforgiving.

I also don't buy his sob story about not being able to get a private plane back to the US. If you can afford to have your wedding in Greece and then have a European extravaganza as your honeymoon, you can find some way to get back to the US safely. But he then felt compelled to get back here right away instead of trying to amass the money to get back on a private jet. I don't buy all that bunk about being "simple people". Simple people have weddings at their local Knights of Columbus hall.
What Andrew Speaker did was unacceptable. If I was sick with a highly contagious disease, I wouldn't put others at risk, especially young kids, the elderly and those who don't have a strong immune system. He had no right to do what he did. He does not deserve forgiveness.
I think that Speaker was wrong for what he did. He put other people's lives at risk to save his own and he should be punished. Some comments have pointed out that he was just trying to get help, but would you feel the same if you were on that plane, or your children, or your parents?

I understand fearing for your life, but is your life more valuable than anyone elses. So lets say he makes it to Denver to receive treatment and he lives. That's great for him, but what if 5 others who were on a flight with him contract TB and die. Is Speaker's life more valuable than those 5? Lets say 1 person dies, is Speaker's life more valuable than that one? Speaker intentionally put other lives at risk just to save his own. That is a fact. If you were in the seat next to him, would some of you still be so understanding?
Perhaps Mr. Speaker honestly didn't "mean" anyone else harm, but the fact is the only control he had over the possibility was choosing NOT to travel and choosing NOT to put hundreds of others at risk of exposure to a deadly disease.

Instead, he chose himself, his honeymoon, his life.

And what about the choices of those people exposed? How many of them would have willingly chosen to be confined, for hours, in closed-air system with Mr. Speaker if they knew the facts? And what does Mr. Speaker have to say about to them now? "I'm sorry" seems very little compensation for their anxiety and the potential threat to their health.

Mr. Speaker is right about one thing. Even if nobody he exposed gets sick, he should NOT expect anyone he put in danger to ever forgive him or his choice.

So please FORGIVE the rest of us Mr. Speaker if we choose to remind you of your choice by choosing NOT to hire you, choosing NOT to ride in an elevator with you, choosing NOT to shake your hand, choosing NOT to have you to our homes or around our families... and choosing NOT to be further exposed to your deadly disease now that we know how little regard you have for our health and right to choose.

We don't expect you to forgive us either.
The things people are saying are just horrible. He was told he was not contiagious and it was not until he was already in Europe that he found out that he had a drug resistant form of TB. Did anyone tell him he was now contiagious? No one could have told him that therefore I would think he would still be operating under the assumption that he was not.

Also, all of you people are talking about how horrible this is for him to have done. At the same time as the lead in suggests, people fly with high infectious communicable diseases all the time nevermind the risk to other people. Since, I am an adult and I have never had chicken pox (and there is a question whether the vaccine works at all) if I sat next to the author on a plane I could have easily caught chicken pox from them and as an adult it would be a life threatening illness. Everyday, people come to work with strep throat, bronchitis, tonsilitis, sinus infections, pink eye and other illnesses because they are so self absorbed they don't think of others therefore I don't see this as a problem that is unqiue to Andrew Speaker. He was told he's not contiagious, yet all of you send your kids to school and go to work when you are sick and knowingly contiagious. He who is without sin cast the first stone.
Chris/Dr. Gupta: I appreciate your candid take on this situation. I am pretty sure that my Mom would have thought I was faking and sent me off to school too!

This episode brought several things to light:

1) Epidemiology is global - "closing" the borders is not a foolproof solution.

2) Alerting ONLY the US citizens who came into contact with Mr. Speaker took several days, and in a true emergency would have been too slow and ineffective at protecting US citizens from all those who were NOT US Citizens and as a result not alerted.

3) Mr. Speaker is a lawyer (Atlanta-based no less), and should know better. He should be required to reimburse state, national and international authorities for his blatant disregard for public safety.

4) Surveillance and communication with the public is inadequate in the US. In a true infectious disease emergency we cannot afford to take several days to identify, isolate, test and inform the public.
I would like to know If Mr. Speaker truly wasn't told he should not travel then why did he sneak back into the United States through Canada?
Message from Canada

I am appalled Speaker used Canada as his gateway to enter the US. I am very concerned about this. I am in the process of contacting governement officials to find out why he was not put on our "no- fly" list. TB is TB, any one with any intelligence knows it is contagious. He boarded five planes on his globe trotting honeymoon.

Dr. Gupta, I would really like to know if there is any form of TB that is NOT contagious?

He should have stayed put. Why did he leave two days earlier?

Taking a plane to Prague and flying into Canada is totally irresponsible. He fled Rome after his phone call with the CDC.

Canadian and US officials should be working together to make determine if in such a circumstance the person should be put on each other's "no-fly" list. I assume they conver when it is a suspected terrorist.

I would like to see this incident investigated further in Canada.

Doris
Canada
I think Mr.Speaker should be held libel for his selfish actions. It is one thing not know you are contagious. But an entirely another thing to know you are and then run with out any precautions.

Once he became aware he had a dangerous form of TB he should at the very least got a mask to cover his face while he traveled. His father-in-law works for the CBC and is a TB specialist, so it's not like he was unaware of how to protect others .

If I had contact with this man, I would sue him, regardless whether I contacted TB on not. The emotional trauma would be enough pain to last for years and the fear of not knowing whether there was another Mr. Speaker by me, would cause me to say the very least, to become overly paranoid of others.
Mr. Speaker should absolutely be held liable for his actions. He is himself a personal injury attorney. Were Mr. Speaker the lawyer representing the passengers, rather than a possible defendant, he would likely take the guilty party for all he was worth.

There are always going to be selfish people, such as Mr. Speaker who put no value on the personal worth of other human beings. That's why we have our legal system, to reign in the sociopathic impulses of people who could care less. Now it's time for that legal system to discipline Mr. Speaker and to correct the CDC, so that it does better in the future to protect American and international lives.
Just watched Dr. Gupta program about how safe is our food. I have one question. If a person grows their own spinach or lettuce at home, is there a risk if you use cow mature as a fertilizer. Keep up the good work.
MRR
If I had TB, "just" influenza, or merely suspected whooping cough, I wouldn't fly in the first place. I'd put off my travel until I felt better, or was declared safe to travel by my doctor. It's just too easy to spread something dangerous while traveling by air.

And if I had only been informed that I had XDR-TB while in Italy, as Speaker was, I'd have used the opportunity to enjoy some of the world's BEST health care and some of the leading experts on TB--in Italy or France.

But then, I'm aware that Italy and France have excellent health care and superb TB facilities. I expect the hospital food would be better, as well.
okay, most comments so far go along the lines, "if i had been him, i wouldn't have gone at all, especially if i knew i had tb..." the question is, "WOuld you really?" well, if you have ever jay walk to cross the street, then you shouldn't say the former statement b/c apparently, "If i were you, i wouldn't do that cuz i kno how dangerous that can be!". Of course, the main article states a better example with chicken pox.

the point is, if you remember in an interview, he was promised by U.S. govt officials to be helped brought back in some way. Also, he was notified/found out he was severely contagious or at a dangerous level, etc... after he was already in Europe.

Now some of you are arguing that the best TB hospitals/facilities are there and he should have gone to them. You're assuming they'll automatically take him in. But will they? if they can, then our hospitals shouldn't even ask for a green card! or whatever it is they require. chances are, they would detain him, place him in quarantine, and then who knows what for how long. He won't be home for a long time, and not with his family. Yes, don't forget he has a family.

You're saying he's selfish to put many others in danger for himself. Well, I don't know about you, but that's happening everyday and by many others as well. I don't see you attacking your coworkers who probably come in with streps throat or the flu in the form of a cold. And don't forget he has a family. Putting his family in danger? are you going to counter argue with that? I don't think that matters much anymore b/c it seems they would stand by his side regardless. Like taking a bullet for a family member isn't it? Or saving a family member at all cost regardless of the damage to you. No, i think one reason he also went on that plane was to get his family back into the U.S. as well.

To truly understand Speaker, put yourself in a situation in which you panic because you're life is on the line. It's not enough to put yourself in his shoes in your mind. You have to experience the helplessness he felt. by the way, make sure you're in a different county/country you've never been to before, not knowing much about the area. Oh yeah, don't forget to bring your family b/c like I said, to truly understand, your situation must be as close to Speaker's before you can truly compare.

Understand this: what many people have been doing is attacking without seeing what might have been the cause of his decision. We tend to do that - only look at the result. We don't look at how or what was put in, whether there were any outside interferences, or certain choices we cannot take due to another's influence. To say that "if I was him... I wouldn't have done that..." is ignorant because apparently, you're ignoring all the possible causes, blocks, holds, obstacles, fears, the environment, and the fact that he's not at HOME, as well as his panicking mind and the fact that he has a family.

I believe some of you think a life of being quarantined is easy. Not only that, but you're doing other people a good thing by not allowing the disease to spread. Well... if you've ever been forced to stand in the corner for getting into mischief as punishment, you sir/madam, are being quarantined and this time, it's not just for 20 minutes... it's for until you're TB level is considered safe and not contagious. Try it. Just stand there in the corner. forget your job, you'll be infecting others anyway. Don't worry about the money, your wife and child can do that. and you can talk to them over the phone so you'll never be out of contact. It's just, you're in Europe in the best TB facility while you're family's at home.

I don't like to be separated from my family and I don't like to be separated from my home. Home is where I feel safe, and my family is who i feel comfortable with. Maybe that's what was in Speaker's mind eh?
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